Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter III: Burn Injury
Adjuvant Treatment
United States Department of Defense
The burn patient who has been actively immunized against tetanus should be given a booster dose of tetanus toxoid. Those patients who have not received prior active immunization should receive hyperimmune human antitetanus serum as well as an initial dose of tetanus toxoid, with active immunization continued at weekly intervals until complete.
Unless specifically contraindicated, penicillin is administered to all burn patients for the first 5 days postburn to prevent beta-hemolytic streptococcal burn wound infection. Thereafter, antibiotics are administered only on the specific indication of clinical infection supported by positive bacteriologic cultures.
As previously noted, restlessness and agitation frequently can be relieved by insuring adequate oxygenation. The need for analgesia is usually minimal except in those patients with extensive partial-thickness burns. Analgesia, when required in the first 3 days postburn, should be administered intravenously in appropriately small dosages.
Ileus is a common accompaniment of thermal injury involving 20% or more of the total body surface, and nasogastric intubation and drainage to prevent emesis and aspiration are critically important in these patients. It is also important to maintain nasogastric intubation in all patients who are to undergo air evacuation, not only in the early postburn period but also later, if evidence of gastrointestinal dysfunction exists.